Faith and Mental Illness

"On one hand, a naturalistic perspective reduces human beings to a mass of physicochemical accidents. On the other hand, a hyper-supernaturalistic reaction is to treat physicochemical problems simply as spiritual maladies. Good theology is not enough, but bad theology kills—literally, physically and spiritually."

Why on earth would Modern Reformation imagine that it had something important to say, from a distinctly Reformation perspective, on mental illness? That was a big question we discussed in our editorial meeting. By the end, though, after sharing our own experiences, the answer became clear. To the extent that evangelical attitudes reflect theological imbalances—and even errors—we think we have something indeed to contribute.

Like their neighbors, Christians acknowledge that people suffering from cancer, AIDS, migraines, or cerebral palsy are still responsible for their actions. Their suffering does not entitle them to hatred, self-loathing, or the mistreatment of others. And yet, we allow room. With even a modicum of sympathy, we recognize they are miserable in ways that are not just limited to their physical distress. First, we want to relieve their immediate pain and, as much as possible, the effects of their disease; we seek every possible medical treatment for them. If a brother or sister has cancer, diabetes, or a stroke, we pray that God will give the doctors and nurses wisdom and skill to relieve their suffering. We realize there is an important place for caring for their bodies and souls, for their medical needs—which are beyond the church's competence—and for their relationship with God.

And yet, when it comes to mental illness, we still don't really believe that it is a medical problem. Many of us were raised in an era when "it's all in your head" meant that mental illnesses weren't real—at least not as real as a broken arm. This tendency reflects not only a lack of appreciation for the rapid growth in medical diagnosis and treatment of such disorders, but a cluster of theological misunderstandings. So here are a few introductory theses to consider.

1. We are not souls incarcerated in bodies, but body-soul creatures.

Contemporary brain science has shown the remarkable extent to which our thoughts, feelings, attitudes, and actions are connected to our bodies—specifically, our brain and chemical interactions. This leaves no room for the soul if we reduce ourselves to what can be subjected to observation and repeatable experiments. The fact that body and soul are so intertwined is elementary for a biblical view of humanity.

"Mind over matter" betrays a pagan rather than biblical view of human beings. We've all heard stories of the Christian Science or neo-Pentecostal family that fatally withheld medical treatment from a child in expectation of a miraculous recovery. As much as we—that is, more traditional Christians—shake our heads at such folly, much of evangelical Christianity differs only in degree. It's amazing that at a time when many churches, including evangelical ones, turn the gospel into a form of personal therapy, psychiatry itself is seen as somewhat threatening.

According to Scripture, reality is not divided between spirit/mind and matter, but between God and everything else. There is the Triune Creator—and his creation. Angels and human souls are no more divine than antelopes or fingernails. In the totality of our existence, we are not God and yet we are like God: created in his image—that is, in true holiness and righteousness.

Because we are psychosomatic (body-soul) unities, physical and spiritual issues intersect in ways that can't be easily pulled apart. A person suffering from a spinal cord injury will be especially susceptible to bouts of spiritual depression, doubts, and even anger. The same is true of mental illness. On one hand, a naturalistic perspective reduces human beings to a mass of physicochemical accidents. On the other hand, a hyper-supernaturalistic reaction is to treat physicochemical problems simply as spiritual maladies. Good theology is not enough, but bad theology kills—literally, physically and spiritually.

It is therefore a biblical view of the human person that cautions us against dismissing physical trauma as an illusion or spiritual and moral responsibility. We may rush to the emergency room after a skiing accident, but when it comes to mental illness, we're more reticent. We wonder if mental illness is on a par with heart disease and spinal injury. We're justly wary of a scientific naturalism, known as "reductive physicalism," which excludes spiritual and sometimes even moral factors from behavior. But we are in danger of also rejecting the overwhelming scientific evidence of the role that brain chemistry plays in our lives. This is threatening only to a body-soul dualism that has far more to do with pagan philosophy than the Apostle Paul. The "real you" is not just your soul but you as a body-soul unity: distinction without separation.

While reductive physicalism flies in the face of Scripture and lacks any scientific evidence, the biblical view of human beings as body-soul unities should already prepare us to accept that every spiritual problem has a physical component—and vice versa.

2. Sin is a condition, not just actions.

According to a 2008 Baylor study, 36 percent of church attendees with mental illness said that they were told by their leaders that it was the result of sin; 34 percent said they were told it was a demon; 41 percent were told they didn't have a mental illness; and 28 percent were even told to stop taking medication. (2) "Deliverance ministries" make a lot of this second point. Many believe that demons bring "generational curses," passed down from generation to generation.

This astonishing perspective is as theologically aberrant as it is medically dangerous. It comes from a theological tradition that reduces sin to specific things that you do or don't do—or perhaps something you inherit, not genetically but by intergenerational demonic activity. There is simply no appreciation for the biblical gravity of the sinful condition in such a view.

In a biblical perspective, sin isn't just something we do or don't do. It arises out of a sinful condition. Just as the whole self is created in God's image, the whole self is fallen in Adam. Consequently, we are sinners and sinned against, victimizers and victims. We are caught up in a maelstrom of living on this side of the curse, and many of its effects are in no way dependent on a specific sin, demonic attack, or anything else for which one is personally responsible. That is not to say that we are not personally responsible for our sin, but that the sinful condition is far greater in its extensiveness than that.

But even in conservative churches where Pentecostal excesses are eschewed, there is often a tendency to blame physical suffering on specific sins. We can be like Job's counselors, assuming that he had done something to deserve his calamities. If he would only ferret out the sin and come clean with it, then God would restore his fortunes. But neither Job nor his friends had access to the first chapter, where God permitted Satan to test Job so that something greater than physical health, wealth, and happiness would appear. Satan meant it for evil, but God intended it for good. Job's suffering brought him to the confidence he expressed in chapter 19: "As for me, I know that my Redeemer lives, And at the last He will take His stand on the earth. Even after my skin is destroyed, Yet from my flesh I shall see God; Whom I myself shall behold, And whom my eyes will see and not another. My heart faints within me!" (vv. 25-27). Neither his friends nor a modern naturalism would be able to explain the ultimate purpose for Job's suffering from the available data. And in our own suffering, we do not have access to "chapter 1" either. All we see are the natural causes and the divine revelation that God works all things together for our good, because he has already triumphed over sin and death in Jesus Christ.

When combined with a mind-body dualism that places mental illness exclusively on the spiritual side of the ledger, this linking of suffering to particular sins (and therefore its remedy of simply more faith and obedience) is toxic—both spiritually and physically. If psychology (more than psychiatry) as a discipline reflects an obvious bias toward reductive physicalism, many conservative churches tilt toward a reductive spiritualism or moralism. That leads to the next point.

3. God works through intermediaries or providence (i.e., what theologians call "common grace"), not just directly through miracle (or saving grace). Science is a gift of God when it recognizes its own limits.

We never tell people with cancer, "Just pray more and read your Bible more." Why, then, do nearly half of evangelicals believe that mental illness can be cured only by more prayer and Bible study?

Traditional Christianity affirms the importance of secondary causes—that is, natural causes—through which God orchestrates every detail of human existence. Ordinarily, God does not act immediately and directly, but indirectly through secondary causes. It's interesting that in Genesis 1 and 2, we have not only the direct command, "Let there be...!" followed by the report, "And there was...," but also the command, "Let the earth bring forth...!" with the report, "And the earth brought forth...." Even in this mighty act, God created the world out of nothing (ex nihilo), and he worked through the physical elements and processes he himself had created to bring about their fruitfulness. Both are God's acts. When he sustains the world each moment even now, in the Son and by his Spirit, the Father ordinarily guides the natural processes he put in place rather than acting as the only cause, as he did in bringing everything into existence in the first place.

Ironically, many conservative Christians share with their secularist nemeses a false dilemma: God is either active in the world in obvious and miraculous ways, or not at all. In reaction against an atheistic pseudoscience, we risk creating our own hyper-supernaturalistic pseudoscience. Instead of seeing medical science as addressing natural causes, both naturalists and hyper-supernaturalists expect their theories to explain everything. Human beings are only bodies or only souls. There are either natural remedies or supernatural remedies. This is a dangerous standoff and it results from false theological premises.

What's missing is a robust doctrine of providence where God is at work in every moment and in every atom, but through secondary means. Naturalism says that there is nothing beyond the natural means; hyper-supernaturalism downplays the natural means that God uses. All that's left is to see God in the miraculous—his direct activity in the world—or not at all. My wife and I prayed for God to heal our triplets when they were born prematurely with various complications. We didn't care whether it was a miracle or God's providential work through excellent physicians and nurses. As it turned out, it was the latter. Either way, God answers prayer. Why can't our prayer be that God would work through the skill of the physicians looking after us and our loved ones? Is that any less God's work than the parting of the Red Sea? Our tendency to hesitate—or even to answer no—betrays a weak view of providence, as if to say "God did it" means that he didn't do it through ordinary channels that he himself also created and gifted.

Among the means through which God brings his plans to pass is prayer. And yet prayer isn't magic. The Reformer John Calvin noted that God still determines the outcome, based on his loving and wise counsels. But we don't know his secret plans, and he works ordinarily through natural means. Just as Christ himself in Gethsemane did not "turn His eyes to the divine plan but rested His desire that burned within Him upon His Father's knees," we too "in pouring out prayers do not always rise to speculate upon the secret things of God." (3) Instead of trying to decode God's hidden purposes, our prayers should focus on the good he has published concerning us. We should be as bold in our prayers as the biblical examples repeatedly encourage. Once more the fatherly image dominates in Calvin's exposition: "We are permitted to pour into [God's] bosom the difficulties that torment us, in order that he may loosen the knots that we cannot untie." (4)

4. Christ came to heal the sick, not those who are well (or who think they are).

"Pray more" and "Read your Bible more." In itself, this is good advice. But what suffering people of any type need most is good news! When you're depressed, being told that you just need to "trust God more" or be more devoted to spiritual exercises simply drives you deeper into yourself. Because of your body's chemistry, you're not in a position to get out of bed and face the day. Apart from the gospel, calls to more prayer and Bible reading become burdensome laws that drive us farther from resting in Christ. It's the proclamation of the gospel in word and sacrament that pulls us out of ourselves to cling to the Father of all mercies in his Son, by his Spirit, and to seek his revealed purposes and will for our lives.

Here's the key point: Prayer and Bible reading aren't therapies at all, much less replacements of or competitors with medical prescriptions. Ironically, many Christians like to quote the latest study indicating the psychological benefits of prayer, even while downplaying the legitimacy of psychiatric treatments. Prayer is simply talking to God the Father, in the Son, by the indwelling Holy Spirit. Reading the Bible may be "therapeutic," but only because we're looking for something more: namely, the truth about God, ourselves, our world, our hopes and fears, and reconciliation with God in his Son.

When the focus is on the Christ, who is proclaimed to us in the gospel, we can pray with honesty, casting ourselves on God's mercy. We aren't coming to a judge, or even to a therapist, but to our heavenly Father who has accepted us in his Son. We're not rubbing a lamp and making a wish, but we are children crying out to the sovereign God who cares for us and answers our feeble, half-hearted, and even intemperate rants with love, wisdom, and compassion.

Furthermore, Calvin notes, "Our prayers are acceptable to God only insofar as Christ sprinkles and sanctifies them with the perfume of his own sacrifice." (5) He adds, "The one true aim of prayer consists in the fact that the promises of God should have their way with us." (6) As the gospel is the soil of faith, faith—this "firm assurance of mind that God is favorable and benevolent to them"—is the root of sincere prayer. (7)

5. Christ saves the whole person, but sanctification is a process that is never finished in this life.

Just as the whole person is created in God's image—neither divine nor demonic, and wholly fallen in body and soul—the whole person is justified and is being renewed daily in Christ's image. This renewal at present is evident spiritually. While the body wastes away toward the grave, the "inner self" is being renewed day by day (2 Cor. 4:16).

We would all like to reach a safe haven, a plateau of health, where we no longer struggle with sin or the physical and emotional pains of daily dying. But we don't find this safe landing place in our experience—either physically or spiritually. The only safe haven is Christ himself, who has objectively conquered sin and death, and who intercedes for us at the Father's right hand until he raises us bodily for the everlasting Sabbath.

6. Triumphalism sets us up for a fall; the theology of the cross and the resurrection give us faith, hope, and love.

Job's friends were as plagued with a theology of glory as Job himself was with whatever physical ailments he suffered. As said above, triumphalism ignores the reality of sin as a condition. Everything is easily explained: Good people live healthy lives; if you're suffering, you need to figure out where you've failed God.

Yet Scripture teaches otherwise: We are baptized into Christ. What was the pattern of his life? Instead of taking the easy way out—Satan's offer of glory now—he embraced the cross, not out of Stoic resolve, but out of "the joy set before him": namely, our salvation (Phil. 2:5-8). By his suffering, the sting of death (the curse of the law) has been removed (1 Cor. 15:56-57). But we still follow him from death to victory, but that victory over the pain of sin and death does not lie on this side of glory (Rom. 8:18-25).

A robustly biblical theology of the cross and resurrection fixes our hope on Christ, who knows our suffering more than we do and who has overcome it objectively. We live in our Christian families and in our churches in that in-between time, awaiting the day when we share fully—in body and in soul—in Christ's glory. Our churches have to be a place where we "wait for it with patience" together. In the process, we need better soul care that appreciates the extent to which physical—and mental—suffering can be relieved in the meantime. Christians should welcome these advances as signs of God's orderly providence and compassionate care for his creatures. There will always be a central place for spiritual care—especially the faithful ministry of preaching, teaching, sacraments, prayer, and discipline. But, like a kid with a broken leg, getting people to the "emergency room" may be the first order of business.

1 [ Back ] See http://blog.lifeway.com/newsroom/2013/09/17/half-of-evangelicals-believe-prayer-can-heal-mental-illness.2 [ Back ] See http://www.baylorisr.org/wp-content/uploads/stanford_perceptions.pdf. 3 [ Back ] John Calvin, Commentary on the Psalms 1:353. 4 [ Back ] John Calvin, Commentary on Genesis 1:489. 5 [ Back ] John Calvin, Commentary on the Psalms 1:336. 6 [ Back ] Quoted in Wilhelm Niesel, The Theology of John Calvin (Cambridge: James Clarke and Co., 1956), 157. 7 [ Back ] John Calvin, Institutes 3.20.12.

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Michael Horton is the J. Gresham Machen professor of apologetics and systematic theology at Westminster Seminary California (Escondido, California), host of the White Horse Inn, national radio broadcast, and editor-in-chief of Modern Reformation magazine. He is author of many books, including The Gospel-Driven Life, Christless Christianity, People and Place, Putting Amazing Back Into Grace, The Christian Faith, and For Calvinism.

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